Early Primary Fascial Closure Promotes Better Outcomes
Indication for Use:
• Support and stabilize the abdominal wall
• Prevent loss of domain
• Prevent abdominal fascia damage
• Prevent lateral retraction of abdominal wall fascia
• Facilitate primary closure of abdominal wall fascia
AbClo Abdominal External
2x Rectus Muscle Splint (RMS) | 1x Circumferential Dynamic Retainer (CDR)
Costs of Failing to Achieve Closure
Patients that fail to achieve primary closure cost on average $150,000 more than those that are closed primarily.
3x Complication Rate
6x Length of Stay
2x Number of Surgical Procedures
Open Wounds, Including Open Abdomens, Impose Serious Clinical Consequences
Dynamic Action of AbClo
1. Unlike static devices, dynamic therapeutic tension rapidly addresses the challenge of the open abdomen. AbClo’s therapeutic tension addresses the inertia required to return wound edges back to the midline for definitive primary closure.
2. How? Cyclic stretching of tissue decreases muscle atrophy and facilitates re-approximation of the abdominal wall fascia.
3. AbClo can be applied and managed by healthcare professionals at the bedside: no need to take the patient to the OR.
Open Abdominal Wounds
AbClo Abdominal Fascial Closure System facilitates early fascial closure of mid-line abdominal defects through non-invasive traction.
Application of the AbClo System prevents lateralization of the fascial margin by engaging the abdominal wall muscles and applying a gentle, unrelenting dynamic appositional force. AbClo gradually reapproximates the fascial edges preventing damage to the skin and abdominal wall fascia. It is beneficial for primary fascial closure.
Closure of the abdominal wall fascia restores normal physiology, which in certain cases has been shown to reduce length of stay, short-term morbidity risks and future health costs.
Case Study 1
Trauma & Stoma
Patient Information
- 41 year-old male; BMI 31.1 Kg/m²
- Gunshot wound to the abdomen
- On arrival at the Trauma Center; Patient was awake and hypotensive
- Chest X-ray: Pneumothorax (R)
- Pelvic X-ray: Bullet in Pelvis
- Fast Ultrasound: Positive abdominal fluid
- Injuries:
- Expanding retroperitoneal pelvic hematoma
- Perforated cecum and right colon
- The patient taken to the Operating Room
Operative Management
- Massive Transfusion Protocol (MTP) active & Tranexa (TXA)
- Chest tube placed for (R) Pneumothorax
- Initial Damage Control procedures:
- Damage Control Laparotomy (DCL)
- Vascular exploration of pelvic vessels
- Right hemicolectomy (left in discontinuity)
- Packing of non-surgical bleed in the pelvis
- Fluid Status:
- +15L Crystalloids + Vasopressors
- 5U packed red blood cells (PRBC) + 2U fresh frozen plasma (FFP)
- “Open Abdomen” with AbThera; Logistic reason
- Interventional Radiology
Case Challenges
- Cumulative Fluid Balance:
- +10.2 L on the day of closure
- Ileostomy
- Patient required 3 take-back surgeries
Adversity
- AbClo placement was delayed by 24 hours.
- Proper orientation to place AbClo as soon as possible after the abdomen is left open.
Solution
- Primary Fascial Closure (PFC) achieved on Post-Op day #6.
- PFC achieved on second take-back surgery.
- Consistent gradual decrease of the fascial gap achieved with AbClo over the postoperative period despite late placement of AbClo and 3 take-back surgeries.
- Only one AbClo was used throughout the entire treatment.
- Fascia and skin were undamaged.
Post-Op: 24 hours
Abclo is Placed on the Open Abdomen in the ICU
Post-Op: Day 6
Successful Re-approximation for Definitive Closure
Post-Op: Day 7
Successful Closure Achieved
Case Study 2
Acute Care Surgery & Elderly Stoma
Patient Information
- 80 year-old male; BMI 32.8 Kg/m²
- Chronic renal failure; Failed renal transplant
- Generalized peritoneal signs
- Abdominal CT scan showed:
- Free air
- Free fluid
- Perforated sigmoid colon
- Patient in septic shock; on Vasopressors
- Patient taken to the Operating Room
Operative Management
- Findings:
- Perforated sigmoid; diverticulitis
- Diffuse peritonitis
- Initial Damage Control procedures:
- Damage Control Laparotomy (DCL)
- Sigmoidectomy
- Descending colon left in discontinuity
- Rectal stump closed
- Fluid Status:
- +2L Crystalloids + Vasopressors.
- “Open Abdomen” with Abthera + AbClo; Logistic and physiologic reasons
Case Challenges
- Chronic renal failure: Failed kidney transplant
- Hartmann’s procedure
- Intra-abdominal sepsis
Adversity
- Patient required 4 take-back surgeries to manage initial morbidities.
Solution
- Primary Fascial Closure (PFC) achieved on Post-Op day #9.
- PFC despite after 4 take-back surgeries.
- AbClo was placed at the bedside immediately following DCL.
- Only one AbClo was used throughout the entire treatment.
- AbClo reduced and maintained the reduction of the fascial gap over the entire postoperative period.
- Fascia and skin were undamaged.
Post- Op: Immediately Following DCL
AbClo Facilitates Reapproximation at the Bedside
Successful Primary Fascial Closure
Case Study 3
High BMI + Grade V Liver Injury + Blunt Abdominal Trauma
Patient Information
- 21 year-old male; BMI 65.8 Kg/m²
- Blunt abdominal trauma from fall resulted in:
- Grade V liver injury
- Small bowel and colon injury
- Patient arrived in emergency room presenting as
- In severe hemorrhagic shock
- Coagulopathic
- The patient taken to the Operating Room
Operative Management
- An initial attempt at laparoscopy caused a trocar injury to a small bowel loop
- Initial Damage Control procedures:
- Damage Control Laparotomy (DCL)
- Resection of devascularized liver segment
- Liver packing
- Small bowel and colon resection left in discontinuity
- Fluid Status:
- +31.1L crystalloids + Vasopressors
- 20U packed red blood cells (PRBC)
- “Open Abdomen” with skin long closure + AbClo; Logistic, physiologic and anatomic indications
Case Challenges
- BMI of 65.8 Kg/m²
- 11 days of Open Abdomen
- 5 Take-back surgeries required before closure
- Colostomy
- +23L on the day of primary fascial closure
Adversity
- AbClo applied despite no AbThera.
- Note: Proper application of AbClo calls for concomitant use of AbThera.
Solution
- Primary fascial closure achieved on Post-Op day #11:
- 5 Take-back surgeries before closure
- And a required Colostomy.
- AbClo moved ALL LAYERS of the abdominal wall despite BMI of 65.8 kg/m².
- Only one AbClo was used throughout the entire treatment.
- No complications related to the abdominal wall closure.
- Fascia and skin preserved.
AbClo Placement:
Provided Pink Sponge Used to Protect Skin in Obese Patients
CT Scan With AbClo:
Action of AbClo Promoting Re-approximation of the Rectus Abdominis Muscles Following Skin-Only Closure
AbClo Management:
Skin Only Closure Without AbThera, an Open Fascia and Colostomy